BACKGROUND: Since the introduction of helmets in winter sports there is on-going debate on whether they decrease traumatic brain injuries (TBI).
METHODS: This cohort study included 117 adult (≥16 years) snowboarders with TBI admitted to a level 1 alpine trauma center in Switzerland between 2000/2001 and 2010/2011. The primary objective was to examine the association between helmet use and moderate-to-severe TBI. Secondary objectives were to describe the epidemiology of TBI over the last decade in relation to increased helmet use.
RESULTS: Of 691 injured snowboarders evaluated, 117 (17%) suffered TBI. Sixty-six percent were male (median age 23 years). Two percent of accidents were fatal. Ninety-two percent of patients sustained minor, 1% moderate and 7% severe TBI according to the Glasgow Coma Scale. Pathological computed tomography findings were present in 16% of patients, 26% of which required surgery. Eighty-three percent of TBIs occurred while riding on-slope. There was no trend in the TBI rate over the studied period, although helmet use increased from 10% to 69%. Comparing patients with and without a helmet showed no significant difference in odds ratios for the severity of TBI. However, of the five patients requiring surgery only one was wearing a helmet. Off-piste as compared to on-slope snowboarders showed an odds ratio of 26.5 (p=0.003) for sustaining a moderate-to-severe TBI.
CONCLUSIONS: Despite increased helmet use we found no decrease in TBI among snowboarders. The possibility of TBI despite helmet use and the dangers of riding off-piste should be a focus of future prevention programs.